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Graefe's Archive for Clinical and Experimental Ophthalmology

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Open Access 01-08-2019 | Metastasis | Oncology

Pigmentation of conjunctival melanoma recurrences and outcome

Authors: Niels J. Brouwer, Marina Marinkovic, Gregorius P. M. Luyten, Carol L. Shields, Martine J. Jager

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 8/2019

Abstract

Purpose

In primary conjunctival melanoma (CoM), one of the characteristics that is associated with an increased risk of metastases and death is a lack of tumour pigmentation. The aim of this study was to investigate whether the degree of pigmentation of CoM recurrences relates similarly to clinical outcome.

Methods

A data set of 177 patients with a CoM recurrence from the Wills Eye Hospital (USA) and the Leiden University Medical Center (The Netherlands) was analysed. The relation between clinical tumour pigmentation of the recurrences, the characteristics of the primary lesions and clinical outcome was investigated.

Results

In 117 (66%) of 177 patients with a CoM recurrence, tumour pigmentation was known: 71 patients (61%) had recurrences with low pigmentation. Primary lesions had low pigmentation in 39% of cases, which is significantly different (p = 0.001). However, low tumour pigmentation of recurrences correlated with low tumour pigmentation of the primary lesion (p < 0.001). No association was observed between pigmentation of the recurrences and iris colour (p = 0.66). Low pigmentation of the recurrences was not significantly associated with an increased risk for metastases (HR 1.96, p = 0.12) or death (HR 1.79, p = 0.27), whereas primary tumours with low pigmentation did show a greater risk for metastases (HR 2.82, p = 0.016) and death (HR 2.90, p = 0.037).

Conclusions

CoM recurrences are more often lightly pigmented compared to primary lesions. A correlation exists between the degree of pigmentation of primary and recurrent lesions, but recurrences can appear with any degree of pigmentation. Unlike primary CoM, the level of pigmentation of CoM recurrences is not related to metastasis or death.

Isager P, Engholm G, Overgaard J, Storm H (2006) Uveal and conjunctival malignant melanoma in Denmark 1943-97: observed and relative survival of patients followed through 2002. Ophthalmic Epidemiol 13:85–96. https://doi.org/10.1080/09286580600553330 CrossRefPubMed

Triay E, Bergman L, Nilsson B, All-Ericsson C, Seregard S (2009) Time trends in the incidence of conjunctival melanoma in Sweden. Br J Ophthalmol 93:1524–1528. https://doi.org/10.1136/bjo.2009.157933 CrossRefPubMed

Tuomaala S, Eskelin S, Tarkkanen A, Kivela T (2002) Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites. Invest Ophthalmol Vis Sci 43:3399–3408PubMed

Brouwer NJ, Marinkovic M, van Duinen SG, Bleeker JC, Jager MJ, Luyten GPM (2018) Treatment of conjunctival melanoma in a Dutch referral centre. Br J Ophthalmol 102:1277–1282. https://doi.org/10.1136/bjophthalmol-2017-311082 CrossRefPubMed

Shields CL (2000) Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Trans Am Ophthalmol Soc 98:471–492PubMedPubMedCentral

Shields CL, Markowitz JS, Belinsky I, Schwartzstein H, George NS, Lally SE, Mashayekhi A, Shields JA (2011) Conjunctival melanoma: outcomes based on tumor origin in 382 consecutive cases. Ophthalmology 118:389–395 e381-382. https://doi.org/10.1016/j.ophtha.2010.06.021 CrossRefPubMed

Missotten GS, Keijser S, De Keizer RJ, De Wolff-Rouendaal D (2005) Conjunctival melanoma in the Netherlands: a nationwide study. Invest Ophthalmol Vis Sci 46:75–82. https://doi.org/10.1167/iovs.04-0344 CrossRefPubMed

Wong JR, Nanji AA, Galor A, Karp CL (2014) Management of conjunctival malignant melanoma: a review and update. Expert Rev Ophthalmol 9:185–204. https://doi.org/10.1586/17469899.2014.921119 CrossRefPubMedPubMedCentral

Werschnik C, Lommatzsch PK (2002) Long-term follow-up of patients with conjunctival melanoma. Am J Clin Oncol 25:248–255CrossRefPubMed

10.

Brouwer NJ, Marinkovic M, Luyten GPM, Shields CL, Jager MJ (2019) Lack of tumour pigmentation in conjunctival melanoma is associated with light iris colour and worse prognosis. Br J Ophthalmol 103:332–337. https://doi.org/10.1136/bjophthalmol-2018-312018 CrossRefPubMed

11.

Shields CL, Chien JL, Surakiatchanukul T, Sioufi K, Lally SE, Shields JA (2017) Conjunctival tumors: review of clinical features, risks, biomarkers, and outcomes—the 2017 J. Donald M. Gass Lecture. Asia Pac J Ophthalmol (Phila) 6:109–120. https://doi.org/10.22608/APO.201710 CrossRef

12.

Wakamatsu K, Hu DN, McCormick SA, Ito S (2008) Characterization of melanin in human iridal and choroidal melanocytes from eyes with various colored irides. Pigment Cell Melanoma Res 21:97–105. https://doi.org/10.1111/j.1755-148X.2007.00415.x CrossRefPubMed

13.

Ito S, Wakamatsu K (2003) Quantitative analysis of eumelanin and pheomelanin in humans, mice, and other animals: a comparative review. Pigment Cell Res 16:523–531CrossRefPubMed

14.

Mitra D, Luo X, Morgan A, Wang J, Hoang MP, Lo J, Guerrero CR, Lennerz JK, Mihm MC, Wargo JA, Robinson KC, Devi SP, Vanover JC, D’Orazio JA, McMahon M, Bosenberg MW, Haigis KM, Haber DA, Wang Y, Fisher DE (2012) An ultraviolet-radiation-independent pathway to melanoma carcinogenesis in the red hair/fair skin background. Nature 491:449–453. https://doi.org/10.1038/nature11624 CrossRefPubMedPubMedCentral

15.

De Leeuw SM, Smit NP, Van Veldhoven M, Pennings EM, Pavel S, Simons JW, Schothorst AA (2001) Melanin content of cultured human melanocytes and UV-induced cytotoxicity. J Photochem Photobiol B 61:106–113CrossRefPubMed

16.

Larsen AC, Dahl C, Dahmcke CM, Lade-Keller J, Siersma VD, Toft PB, Coupland SE, Prause JU, Guldberg P, Heegaard S (2016) BRAF mutations in conjunctival melanoma: investigation of incidence, clinicopathological features, prognosis and paired premalignant lesions. Acta Ophthalmol 94:463–470. https://doi.org/10.1111/aos.13007 CrossRefPubMed

17.

Scholz SL, Cosgarea I, Susskind D, Murali R, Moller I, Reis H, Leonardelli S, Schilling B, Schimming T, Hadaschik E, Franklin C, Paschen A, Sucker A, Steuhl KP, Schadendorf D, Westekemper H, Griewank KG (2018) NF1 mutations in conjunctival melanoma. Br J Cancer 118:1243–1247. https://doi.org/10.1038/s41416-018-0046-5 CrossRefPubMedPubMedCentral

18.

Beadling C, Jacobson-Dunlop E, Hodi FS, Le C, Warrick A, Patterson J, Town A, Harlow A, Cruz F 3rd, Azar S, Rubin BP, Muller S, West R, Heinrich MC, Corless CL (2008) KIT gene mutations and copy number in melanoma subtypes. Clin Cancer Res 14:6821–6828. https://doi.org/10.1158/1078-0432.CCR-08-0575 CrossRefPubMed

19.

Griewank KG, Murali R, Schilling B, Scholz S, Sucker A, Song M, Susskind D, Grabellus F, Zimmer L, Hillen U, Steuhl KP, Schadendorf D, Westekemper H, Zeschnigk M (2013) TERT promoter mutations in ocular melanoma distinguish between conjunctival and uveal tumours. Br J Cancer 109:497–501. https://doi.org/10.1038/bjc.2013.312 CrossRefPubMedPubMedCentral

20.

Ossowski L, Aguirre-Ghiso JA (2010) Dormancy of metastatic melanoma. Pigment Cell Melanoma Res 23:41–56. https://doi.org/10.1111/j.1755-148X.2009.00647.x CrossRefPubMed

21.

Paridaens AD, McCartney AC, Lavelle RJ, Hungerford JL (1992) Nasal and orbital recurrence of conjunctival melanoma 21 years after exenteration. Br J Ophthalmol 76:369–371CrossRefPubMedPubMedCentral

22.

Brouwer NJ, Genders SW, Marinkovic M, van Duinen SG, Jager MJ, Luyten GPM (2018) Two late recurrences of conjunctival melanoma. Ocul Oncol Pathol. https://doi.org/10.1159/000494978

Title: Pigmentation of conjunctival melanoma recurrences and outcome
Authors: Niels J. Brouwer
Marina Marinkovic
Gregorius P. M. Luyten
Carol L. Shields
Martine J. Jager
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Melanoma
Melanoma
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 8/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-019-04342-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pigmentation of conjunctival melanoma recurrences and outcome

Abstract

Purpose

Methods

Results

Conclusions

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Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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